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MOCA™ Varicose Vein Treatment Using the Patented ClariVein® Catheter

MOCA™ varicose vein treatment using the patented ClariVein® catheter is a new endovascular technique for the treatment of venous reflux disease.
It is the first venous ablation technique to employ a hybrid (dual-injury) technique built into 1 catheter-based delivery system.
1. Endomechanical abrasion of the vessel endothelia is produced by the tip of the catheter’s rotating wire (mechanical component).
2. Endovenous chemical ablation is induced simultaneously by the injection of a sclerosant drug sprayed from the tip of the catheter as it is pulled back.

I have now completed 11 of these MOCA procedures and I can report:

1. It is not more complicated to complete than an EVLT
2. It does not require tumescent anesthesia which translates into a quicker procedure.
3. There is some discomfort from the rotating angled guide wire (3,500 rpm). I have largely solved that by Injecting 3-5cc 1% plain lidocaine directly up the vein via the sheath.
4. Rarely the angled guide wire may get caught on a valve. That can be solved by removing the catheter system retaining the sheath placing a 30 cm-40 cm straight guide wire crossing the valve then removing the 10 cm sheath and replacing it with a 4 or 5 Fr 30 cm sheath and thus crossing the valve then removing the guide wire and reinserting the catheter it will fit in a 4 Fr sheath and then completing the procedure. Alternatively simply inject 1.5% STS (l) proximal to the valve and with the lower Clariven procedure – the proximal portion of the GSV will close. (That happened to me once).
5. At present the success rate is 100%. This exactly matches EVLT, but without the pain.
6. All patients tolerated the procedure well, a few noted mild evening discomfort easily managed with Tylenol or Advil.
7. This patient below was an international soccer coach and player and he returned to his coaching and playing duties the next day. That would be impossible with EVLT. He would have been in significant pain for about 10 days. And likely need another 2 weeks before he resumed his athletic career.
8. Clarivein has applicability to BK GSV reflux, which can essentially be completed in one pass from knee to ankle. That can also be accomplished by ultrasound guided sclerotherapy, but requires additional applications.
9. By excluding heat there is no risk to damaging the long saphenous or the sural nerves.
10. I suspect Clarivein will largely replace EVLT and VNUS procedures in the U.S. in the not too distant future. For two reasons: it is painless and 100% effective. Some clinics (UK and Europe and NY (Dr. Steven Elias) have done over 2,000 procedures each and their publications are available and they more than confirm my experiences.

So my analysis at this point is as follows:

MOCA is as effective as laser (100% effective) and likely more effective that VNUS
It is essentially painless
It does not risk nerve or skin damage.
The procedure is quicker that EVLT due to the absence of tumescent anesthesia needs
Pt can return to then normal daily activities the very next morning without any significant pain

PS I did one pt with a MOCA on the RLE and I selected a Laser on her L prox GSV . She is very adamant that she would never agree ever again to have a LASER done. her pain lasted about 2 weeks and she hobbled about all that time. She had no pain with her MOCA procedure and went out dancing that same evening.

Pre MOCA procedure DVUS:

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Post MOCA procedure:

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Post MOCA procedure flow test  – zero flow

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Clinical Results:

Pre MOCA

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Post MOCA (Clinical)

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